June 13, 2010

IRELAND: Masterclass in resistance a lesson in love

It is all too easy to cross the line between caring for the elderly and bullying, writes Patricia Redlich

MY MOTHER Mary Cribbon was buried this time last year -- on June 16 to be precise -- aged almost 92. Looking back, I now realise that the last five years of her life constituted a masterclass on how to tread that tight-rope between care and bullying, as osteoporosis slowly curtailed her capacity to roam free. Tough-minded, clear-headed, and stubborn to the last, she taught me a truly humbling lesson. Love and abuse can be uncomfortably close bed-fellows.

Close family members are most likely to be the abusers, the statistics tell us. That figures. The overwhelming majority of elderly choose to live out their lives in their own homes. Family, therefore, invariably plays a pivotal role, despite being part of a mobile workforce, in a marketplace that is international, where women, too, have careers, and time is tight. Even where close relatives are not the principal carers -- and professional home help services have moved in to fill that gap -- family is still central to all major decisions in the older person's life. Elder abuse is a domestic affair. That is the challenge.

Three years ago, the HSE bravely attempted to meet that challenge by setting up an elder abuse service, staffed with case workers who intervene, when asked. Requests can be channelled through frontline staff such as public health nurses. Direct contact can be made by ringing the HSE on 1850-24-1850. Or if people wish to discuss the issue in more general terms, they can talk it through with Age Action, contactable on 01-4756989. Last year the service dealt with nearly two thousand allegations -- the tip of the iceberg, it is believed, since international statistics suggest that between 14,000 and 24,000 older people in Ireland have been abused at some time in the latter years of their lives.

The taboo has been lifted. The stark truth revealed. We are often less than admirable in our treatment of elderly loved ones.

Some actions are obviously criminal, like stealing from them, starving them, systematically beating them, or failing in care to the point where it's positively life-threatening -- all carried out by perpetrators of every hue, displaying sociopathic absence of conscience, or simple lack of moral character, or just plain greed. Since it's domestic, it will always be difficult, but in this scenario we can at least envisage various arms of the State stepping in with good authority.

Then there are the essentially good people, over-burdened, exhausted, psychologically put to the pin of their collars, driven beyond their ability to cope, who snap. As Eamon Timmins of Age Action puts it: "Family carers are the great heroes of modern society. Many don't choose to be carers. It just becomes their lot. And support services don't offer unless you ask. Until you raise the flag, you're on your own." A civil society is proactive. That doesn't mean Big Brother. It does mean open advertising of available resources, non-intrusive offers of help from everyone on the frontline, and swift, non-judgmental and conservative intervention when the alarm bell is rung. Neither the elderly person nor the family carer will want the relationship sundered. They just want the situation fixed.

And then there are people like myself and my mother.

She wouldn't wear her emergency alarm bracelet. She said it was too bulky for her tiny wrist. She had a point. It was bulky and her wrist was slim. She wouldn't wear it in necklace form either. It swung when she tried to lift her brittle bones out of the inappropriately soft leather sofa she insisted on using despite endless offers of specially designed orthopaedic chairs, which she said ruined the aesthetics of the sitting room she loved. And hitting the coffee table, the alarm was inadvertently activated. Which was why it couldn't be left on that easily accessible low coffee table either. Mugs of tea could land on it, creating the same kind of chaos.

That bloody bracelet became a metaphor for the masterclass my mother delivered, the battleground of our relationship as she struggled for self-determination, while I struggled to find an acceptable way to do the right thing. Yes, I know. You're protesting that this wasn't elder abuse. People like us don't abuse anyway, you say. But you're wrong, on both counts. Bullying is the ground-floor of all abuse. And it begins, all too often, with that fateful feeling that we know what's best. That bully lay within me, the only consolation being my belief that it lies within us all.

Over the years, my mother's reasons for resisting the alarm shifted. At the beginning, she felt embarrassed when she had to explain that it had gone off by mistake. Conscious of ageist attitudes, she didn't wish to seem dim, or be counted amongst the bewildered, or indeed, experience the indignity of having to explain herself. Later her motivation became more grim, but no less legitimate. She didn't want the ambulance to come and cart her off to hospital. That, she rightly saw, was the slippery slope to institutional care. And she did not want to end up in a nursing home. Death in the form of a huddled bundle at the bottom of her steep stairs seemed preferable.

My mother didn't explain any of this to me. People under siege say silly things, so she talked of ambulances disturbing the neighbours, and other such obvious rubbish. I'm not sure if she ever even consciously accessed her own motivation. How many of us really know why we do things? But in her relentless pursuit of her own agenda, she forced me to sit back on my heels and examine my own attitude. And it was one of selfishness. How would I ever cope with the nightmare of knowing she had died alone, but not ever knowing how long she suffered? How would I ever handle the guilt, remorse and sorrow? I wanted my mother to live, and die, in a way that made me feel more comfortable. She declined.

Wheelchair users will tell you. People often shout, or slow down their speech, or simplify their vocabulary, when talking to them. Physical infirmity inspires a kind of infantilism in the onlooker's approach, the notion that body and mind are so inextricably interwoven that a frail body automatically means a frail mind. Even if it's only a slight curvature of the spine, or slowness in differentiating between different copper coins at the checkout, or slight hesitancy when orienting themselves in a new environment, the elderly are automatically one-down. Seen through kinder eyes, it appears we're hard-wired to shift into helping mode when confronted with perceived weakness. The intention may be benign, but the effect is often that older people feel on the defensive. That's not a good basis for any relationship.

On the other hand, we expect more. Children we can forgive, indulge, enjoy even as they refuse to share our point of view. They are young after all. Even our stroppy teenagers, when we've had a glass of wine, or several beers, can be seen through the benign prism of knowing they've a lot to learn. But the elderly? Aren't they adults like us? Why can't they agree with our point of view? Why are they being so deliberately thick? The angry thoughts are endless, the bottom line always the same. We want them to think as we do. A thousand factors have blurred the barriers. We don't see them for what they are, namely separate, and entitled, to do things differently.

Cutting to the chase, the relationship with our elderly is a potentially combustible combination of a family's sense of entitlement, the inevitable emotional baggage of all parent and child relationships, the demands of duty, sibling rivalry, unfinished business, the insatiable desire to please, the inevitable experience of falling short of expectations, or simply failing. Plus all of what I said earlier, in my attempt to elucidate. Caring for the elderly, in short, is about solving the dilemma of the human condition.

Mary Cribbon, who just happened to be my mother, among many other roles she inhabited, including that of mother to my three sisters and one brother, made one thing clear. Combatting ageism, not to mention elderly abuse, is ultimately an act of love. More accurately, it is the daily exercise of loving. Or what our parish priests no longer feel uncomplicatedly free to say, it is the daily exercise of examining our conscience, in order to be good. Because goodness is not a permanent state of grace. It is a daily struggle.

Patricia Redlich, a trained therapist with a
Masters Degree in Clinical Psychology,
writes the 'Dear Patricia' Problem Page in the
Sunday Independent, Ireland's leading Sunday newspaper.